University of Wisconsin–Madison Medical College of Wisconsin

Pulmonary Blastomycosis: Pediatric Cases Emphasizing Prompt Identification Using C-Reactive Protein and Procalcitonin to Distinguish Fungal vs Bacterial Origin

Charles A. Gusho, BS; Tannor A. Court, BS

WMJ. 2020;119(4):289-292.

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Introduction: Pulmonary blastomycosis is a rare fungal disease with increased prevalence in states such as Wisconsin. Clinical manifestations of blastomycosis may vary from asymptomatic infection to multiorgan, disseminated disease.

Case Presentation: We present 2 pediatric patients with blastomycosis who were initially worked up secondary to cough and fever of suspected bacterial origin, though whose subsequent hospital course was notable for deterioration until antifungal treatment was initiated.

Discussion: In each case, the disease burden was monitored concurrently with serum procalcitonin and C-reactive protein levels, the former of which remained relatively normal throughout the hospital course signifying lack of bacterial involvement.

Conclusion: We emphasize the importance of obtaining an early C-reactive protein and procalcitonin, which may distinguish a bacterial from fungal pulmonary infection such as blastomycosis. This, in turn, may shorten hospital stay and reduce hospital inpatient cost, morbidity, and mortality by means of prompt antifungal intervention.

Author Affiliations: Medical College of Wisconsin – Green Bay, De Pere, Wisconsin (Gusho, Court).
Corresponding Author: Charles Gusho, 110 Grant St, De Pere, WI 54115; phone 414.218.9350; email; ORCID ID 0000-0002-8897-3688.
Acknowledgements: Informed consent was not obtained as there are no data nor figures that explicitly identify the included cases.
Financial Disclosures: None declared.
Financial Disclosures: None declared.
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